Nursing management of patient with cardiac problems

1. PERICARDITIS
Mr.Veerabhadra B.B
Asst Professor
Dept Of Medical Surgical Nsg.

2. DEFINITIO
N
•Pericarditis is acute or chronic
inflammatory process of the
visceral or parietal pericardium.

3. ETIOLOGY
 Idiopathic or nonspecific causes
 Viral Infection: (eg, Coxsackie, influenza)
 Bacterial (eg, streptococci, staphylococci, meningococci,
gonococci)
 Fungal infection (mycotic)
 Disorders of connective tissue: Systemic lupus
erythematosus, rheumatic fever, rheumatoid arthritis,
polyarteritis.
 Hypersensitivity states: immune reactions, medication
reactions, serum sickness

4.  Disorders of adjacent structures: myocardial infarction,
dissecting aneurysm, pleural and pulmonary disease
(pneumonia)
 Neoplastic disease: Lung cancer or Breast cancer,
Leukemia, neoplasms
 Radiation therapy.
 Trauma: chest injury, cardiac surgery, cardiac
catheterization.
 Pacemaker implantation
 Renal failure and uremia
 Tuberculosis
Cont….

5. PATHOPHYSIOLOGY

6. CONT…..
 As a result of excess of exudate fluid collection
(pericardial effusion ) causes compression and
increased pressure over heart
Cardiac tamponade

7. CLINICAL MANIFESTATION
•Chest pain:- Progressive, frequently ,sharp &
pleuritic in nature.
•The pain is aggrevated with deep
respiration& when lying supine.
•It is relieved by sitting.
• The pain may radiate to the neck, arms or left
shoulder.

8. •Chest pain is not relived by nitroglycerin or
morphine. Pain usually 4 to 48 hours before a rub
is heard.
•Pericardial friction rub: Fever, minimal dyspnoea ,
Restless, irritability & anxiety
•Inspiratory jugular vain distension. (kussmaul’s sign)

9. DIAGNOSTIC STUDIES.
 History Collection : To Rule out cause.
 Physical examination: Sign & Symptoms
analysis.
 ECG : To rule out MI, Arrhythmia
 Chest X-ray: To check for pericardial
effusion.
 Blood culture. Complete hemogram. Renal
& Liver Function test. Coagulation test.

10. EKG
Electrocardiogram in acute pericarditis showing diffuse upsloping ST segment elevations seen best here in
leads II, III, aVF, and V2 to V6. There is also subtle PR segment deviation (positive in aVR, negative
in most other leads). ST segment elevation is due to a ventricular current of injury associated with
epicardial
inflammation; similarly, the PR segment changes are due to an atrial current of injury which, in Pericarditis,
typically displaces the PR segment upward in lead aVR and downward in most other leads.

11. PERICARDIAL
EFFUSION
Cardiomegaly due to a massive pericardial effusion. At least 200 mL of pericardial
fluid must accumulate before the cardiac silhouette enlarges.

12. COMPLICATIONS
•Arrhythmias :-
*It may be due to irritation of the sinus node,
which is located close to the parietal
pericardium. Atrial arrhythmias,
*Especially Atrial flutter & ateroventricular
conduction disturbance.

13. •Pericardial Effusion:- accumulation of
fluid with in the pericardial sac is called
“Pericardial Effusion”. The fluid may be
serious, purulent or hemorrhagic.

14. •Cardiac Tamponade:- it develop as the
pericardial effusion increases in size
compensatory mechanism ultimately fail to
decreased cardiac output. This can lead to
cardiac failure, shock & death.

15. TREATMENT
The patient is placed on bed rest until the
fever, chest pain, and friction rub have
subsided.
Treatment of underlying cause.
Antibiotic , Antiviral & Antifungal therapy.
NSAIDs Aspirin (2-5 g/day) , Ibuprofen (300-800
mg q6-8H) , Narcotics
•Corticosteroids (eg, prednisone) may be
prescribed if the pericarditis is severe.

16.  Diuretics : Inj. Furosemide.
 Partial or total pericardectomy
 Pericardiocentesis : To remove excess of
fluid and to relieve symptoms

17. NURSING MANAGEMENT
.1.Adequate rest and sleep.
2.Assist the patient with Daily activities, if
necessary.
3.Hemodynamic monitoring of patients
4.oxygen to prevent tissue hypoxia.
5.Administration of drugs as ordered.
6.Because cardiac tamponade requires
immediate treatment, keep a
pericardiocentesis tray handy if you
suspect pericardial effusion.
7.Health education on followup care

18. THANK YOU
Take Care of Your Heart